Usefulness of the Neutrophil-to-Lymphocyte Ratio in Predicting Short- and Long-Term Mortality in Breast Cancer Patients

Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY, USA.
Annals of Surgical Oncology (Impact Factor: 3.93). 06/2011; 19(1):217-24. DOI: 10.1245/s10434-011-1814-0
Source: PubMed


The neutrophil-to-lymphocyte ratio (NLR) is a strong predictor of mortality in patients with colorectal, gastric, hepatocellular, pancreatic, and lung cancer. To date, the utility of NLR to predict mortality in breast cancer patients has not been studied. Therefore, the aim of our study was to determine whether the NLR is predictive of short- and long-term mortality in breast cancer patients.
Our observational study used an unselected cohort of breast cancer patients treated at the Staten Island University Hospital between January 2004 and December 2006. A total of 316 patients had a differential leukocyte count recorded prior to chemotherapy. Survival status was retrieved from our cancer registry and Social Security death index. Survival analysis, stratified by NLR quartiles, was used to evaluate the predictive value of NLR.
Patients in the highest NLR quartile (NLR > 3.3) had higher 1-year (16% vs 0%) and 5-year (44% vs 13%) mortality rates compared with those in the lowest quartile (NLR < 1.8) (P < .0001). Those in the highest NLR quartile were statistically significantly older and had more advanced stages of cancer. After adjusting for the factors affecting the mortality and/or NLR (using two multivariate models), NLR level > 3.3 remained an independent significant predictor of mortality in both models (hazard ratio 3.13, P = .01) (hazard ratio 4.09, P = .002).
NLR is an independent predictor of short- and long-term mortality in breast cancer patients with NLR > 3.3. We suggest prospective studies to evaluate the NLR as a simple prognostic test for breast cancer.

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Available from: Vijaya Raj Bhatt
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    • "On the other hand, because the NLR is significantly associated with the pathological response to preoperative chemoradiotherapy , the difference in the survival rate in DFS may be partly explained by differences in the treatment response to preoperative chemoradiotherapy between the low and high NLR groups. Consistent with our results, it has been reported that an elevated NLR is correlated with a worse prognosis in many malignancies7891011. Moreover, Fang et al.[12]reported that an elevated NLR is significantly associated with a worse disease-free and overall survival in OSCC patients. "
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    ABSTRACT: Background The Neutrophil to lymphocyte ratio (NLR) has prognostic value in patients with a variety of cancers. However, its prognostic significance in oral squamous cell carcinoma (OSCC) patients has not been fully explored. The purpose of this study was to determine the clinical significance of NLR in patients with OSCC. Methods OSCC patients who underwent surgery following 5-fluorouracil (5-FU)-based chemoradiotherapy were enrolled in this study. The associations between the NLR status and various clinicopathological features were examined, and the effects of the NLR on the prognosis were evaluated. Analysis of circulating interleukin-6 (IL-6) was carried out and correlation with NLR and C-reactive protein concentration (CRP) was examined. Results An elevated NLR was significantly correlated with advanced T-stage and poor response to chemoradiotherapy. Moreover, a Cox regression analysis based on the disease-free survival (DFS) revealed the NLR status (hazard ratio, 2.013; P = 0.041) and pathological response to chemoradiotherapy (hazard ratio, 0.226; P = 0.001) to be significant prognostic factors in OSCC patients. Furthermore, circulating IL-6 was found to correlate with NLR and CRP. Conclusion The NLR is a potential biomarker for predicting the clinical response to 5-FU-based chemoradiotherapy and the survival in OSCC patients, and the systemic inflammatory response may be potential target for improving patient’s prognosis. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2079-6) contains supplementary material, which is available to authorized users.
    Full-text · Article · Dec 2016 · BMC Cancer
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    • "It provides valuable information for the determination of the diagnosis and prognosis of various diseases. NLR has been used in many cardiac and non-cardiac diseases as an indicator of inflammation (Azab et al., 2012). However, to the best of our literature search, no study has documented the NLR as a predictor of the complication and severity of patients with snake bites. "
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    ABSTRACT: Snake bites have cardiotoxicity, neurotoxic, myotoxic, nephrotoxic, and hemotoxic features. The neutrophil/lymphocyte ratio (NLR) provides valuable information for the determination of the diagnosis and prognosis of various diseases. In this study, we aimed to investigate the relationship between NLR with the development of complications and duration of hospital stay in snakebite cases.
    Full-text · Article · Oct 2015 · Saudi Journal of Biological Sciences
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    • "Although evidence on the prognostic role of the NLR in breast cancer has been relatively scarce (Azab et al, 2012, 2013; Noh et al, 2013; Dirican et al, 2014; Nakano et al, 2014; Yao et al, 2014), our robust results add valuable evidence that the NLR is also an adverse prognostic indicator in breast cancer. An earlier study in breast cancer patients, which stratified the NLR according to quartiles, reported that mortality was higher in the highest NLR quartile but closely similar among the lower three quartiles, suggesting a threshold effect (Azab et al, 2012). In our study, although the risk of mortality increased substantially with each NLR quintile in univariable analysis, the observation that this trend was attenuated after multivariable adjustment seems to suggest that the association between the NLR and mortality in breast cancer may not be entirely linear. "
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    ABSTRACT: Peripheral blood-derived inflammation-based scores such as the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) have recently been proposed as prognostic markers in solid tumours. Although evidence to support these markers as unfavourable prognostic factors is more compelling in gastrointestinal cancers, very little is known of their impact on breast cancer. We investigated the association between the NLR and PLR, and overall survival after breast cancer. Data from the University of Malaya Medical Centre Breast Cancer Registry was used. Of 2059 consecutive patients diagnosed from 2000 to 2008, we included 1435 patients with an available pre-treatment differential blood count (∼70%). Patients were stratified into quintiles of the NLR/PLR. Multivariable Cox regression was used to determine the independent prognostic significances of the NLR/PLR. Compared with the first quintile of the NLR, women in quintile 5 were younger, had bigger tumours, nodal involvement, distant metastases and higher tumour grades. Higher NLR quintiles were significantly associated with poorer survival with a 5-year relative survival ratio (RSR) of 76.4% (95% CI: 69.6-82.1%) in quintile 1, 79.4% (95% CI: 74.4-83.7%) in quintile 2, 72.1% (95% CI: 66.3-77.3%) in quintile 3, 65.6% (95% CI: 59.8-70.8%) in quintile 4 and 51.1% (95% CI: 43.3-58.5%) in quintile 5. Following adjustment for demography, tumour characteristics, treatment and the PLR, the adjusted hazard ratio (HR) for quintile 5 vs quintile 1 was 1.50 (95% CI: 1.08-1.63); Ptrend=0.004. Results were unchanged when the NLR was analysed as a dichotomous variable using different cutoff points. Although patients in PLR quintile 5 had lower survival than in quintile 1 (5-year RSR: 53.2% (95% CI: 46.9-59.2%) vs 77.0% (95% CI: 70.9-82.2%)), this association was not significant after multivariable adjustment. However, a PLR >185 was significantly associated with poorer survival; adjusted HR: 1.25 (95% CI: 1.04-1.52). Both the NLR and PLR are independently associated with an increased risk of mortality in breast cancer. Their added value in the prognostication of breast cancer in clinical practice warrants investigation.British Journal of Cancer advance online publication, 28 May 2015; doi:10.1038/bjc.2015.183
    Full-text · Article · May 2015 · British Journal of Cancer
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